Critical care medicine
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Critical care medicine · Nov 1982
Catheter colonization and bacteremia with pulmonary and arterial catheters.
We prospectively studied the incidence of catheter-related sepsis in 51 critically ill patients who underwent 52 arterial and 37 pulmonary artery catheterizations over a period of 3 months. Daily cultures of blood and catheter insertion site were done and the catheters were cultured semiquantitatively at the time of removal. Catheter colonization defined as growth of 15 or more colonies was observed with 9 (10%) catheters and bacteremia with 4 (4.5%) catheters. ⋯ Femoral arterial catheterization appeared to be more often associated with colonization than radial catheters. It appears that the arterial and pulmonary artery catheter colonization occurs in about 10% of catheters and predisposes to catheter-related sepsis. Semiquantitative cultures of the catheter may aid in better documentation of catheter-induced sepsis.
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Critical care medicine · Nov 1982
Flexible fiberoptic bronchoscopy and laryngoscopy in children under 2 years of age: diagnostic and therapeutic applications of a new pediatric flexible fiberoptic bronchoscope.
The new flexible fiberoptic bronchoscope (Olympus BF Type 3C4, Tokyo, Japan) was employed for diagnostic and therapeutic purposes in 96 children below 2 yr of age. Sixty-two laryngoscopies and 34 bronchoscopies were performed without any mortality or significant morbidity. The bronchoscope was helpful in establishing diagnosis and also served as a tool for aspirating secretions and resolving atelectasis. It is concluded that flexible fiberoptic bronchoscopy and laryngoscopy in children 2 yr or younger is a safe procedure and may aid in the diagnosis and therapy of disorders of the respiratory tract in this age group.
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Critical care medicine · Oct 1982
Left ventricular contractility using isovolumic phase indices during PEEP in ARDS patients.
The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip micromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmural right atrial and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt = 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. ⋯ IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV end-diastolic pressure rose markedly. We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.
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Critical care medicine · Aug 1982
Comparative StudyFailure of one method of simultaneous chest compression, ventilation, and abdominal binding during CPR.
Some modified methods of CPR improve carotid blood flow, but there are no studies to show that these modified techniques improve survival, Accordingly, an experimental CPR technique using simultaneous chest compression, ventilation (SCV-CPR), and abdominal binding was compared to standard CPR in beagle dogs. The modified technique utilized a broad-based bellows device that was mechanically compressed, producing chest compression, delivering a volume of air to the endotracheal tube, and pressurizing an abdominal binder. The duration of ventricular fibrillation and CPR was 5 min. ⋯ The aortic diastolic pressure and the diastolic gradient between the aorta and right atrium was significantly different between the 2 groups. Because these pressures relate to the coronary perfusion pressure, they may explain the discrepancy in the survival rate. This study suggests increasing carotid blood flow during CPR will not necessarily improve survival.